Recreational Brisk Walker With Hip Pain

HISTORY: An 80-year-old female with a significant medical history, including treated breast cancer, iron deficiency anemia, thyroid nodules, and chronic skin issues, presented with severe pain and burning sensations radiating from the pubic area to the medial right thigh. She described the pain as significantly impacting her mobility and quality of life. The patient reported engaging in moderate to strenuous exercise, specifically brisk walking, an average of 2 days per week. Each session typically lasted around 20 minutes. The discomfort had been present for years and had been evaluated multiple times, with recent exacerbations leading to an emergency department visit. She endorsed no family history of autoimmune or rheumatologic disease. PHYSICAL EXAMINATION: On physical examination, the musculoskeletal assessment showed normal range of motion and strength, and she maintained a steady gait without signs of synovitis or joint deformities, though tenderness was noted in the proximal, medial region of the right thigh, specifically in the adductor insertion location. Pain was reproduced with gross movement of the right lower extremity. Neurologic examination revealed no focal deficits, with cranial nerves II-XII grossly intact. DIFFERENTIAL DIAGNOSIS: 1. Athletic pubalgia 2. Adductor muscle strain/tear 3. Hip osteoarthritis TEST AND RESULTS: An ultrasound ruled out deep vein thrombosis but identified a Baker cyst. A MRI pelvis without and with contrast showed strains and partial thickness tearing of the adductor longus muscles at the pubic tubercle, right worse than left, which may be seen with sports hernias. FINAL WORKING DIAGNOSIS: Adductor longus tear in setting of prior sports hernia. TREATMENT AND OUTCOMES: 1. The patient participated in physical therapy targeting the adductor and core to reduce strain on the pubic tubercle and improve functional mobility. 2. Over-the-counter medications like acetaminophen were advised as needed for pain relief, with consideration for aspiration and corticosteroid injection of the Baker cyst. 3. The patient was advised on low-impact activities to prevent exacerbations of symptoms. 4. Symptoms were monitored to assess progression, with plans for further intervention if conservative measures proved ineffective.